Left Hemorrhagic Vascular Mass on Vocal Fold

Significance Statement

Vascular lesions of the vocal fold result most commonly as a consequence of malformations, dilatations, or ruptures of the blood vessels supplying the vocal folds and can present with various symptoms. Vascular lesions of the vocal fold can cause severe dysphonia and can sometimes require surgical repair.

Hemorrhagic Vascular Mass

This 21-year-old female singer with a hemorrhagic left vocal fold vascular mass who had undergone unsuccessful steroid treatment and voice rest for her dysphonia presented with persistent dysphonia and reflux-related symptoms. Prior to her presentation to our clinic, she had experienced 2 episodes of sudden dysphonia, which were attributed to bleeding from her vascular mass, as well as symptoms of laryngopharyngeal reflux. Strobovideolaryngoscopy revealed a hemorrhagic vascular mass on the vibratory margin of the left vocal fold and a small reactive mass on the right vocal fold (Figure 1). Despite undergoing reflux treatment and voice therapy, her symptoms did not improve. The left hemorrhagic vascular mass was excised using a mini micro flap (Figure 2).

Figure 1.

The left vocal fold hemorrhagic mass.

Figure 2.

The postoperative vocal folds 9 months after surgery. The sulcus had been present preoperatively but was as apparent in Figure 1.

Discussion

Surgical excision of this patient’s hemorrhagic mass resulted in improvement of the patient’s voice quality and dysphonia. Vascular lesions on vocal folds are commonly due to malformation, dilatation, or rupture of blood vessels that supply the vocal fold due to acute vocal trauma and frequently present with dysphonia and vocal fatigue. ¹ Common causes of traumatic vascular lesions include shouting, forceful coughing, and chronic voice misuse/overuse. However, it is important to recognize that these benign lesions may present. Vascular lesions on vocal folds present typically as 1 of 3 different, but similar types: as a post-hemorrhagic mass, a polyp with hemorrhage, or a varix. ¹ Mild cases may resolve spontaneously with voice rest and voice therapy, while more severe cases may require surgery. Initial treatment of all 3 types consists of relative voice rest, voice therapy, elimination of anticoagulant medications when possible, treatment of concomitant conditions such as reflux, and close follow-up. Management can include observation, medical management, laser cauterization, or surgical excision.^1,2 Persistent dysphonia and the presence of a vocal mass are the most common indications for laryngeal surgery.^1,2